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Tuesday, December 31, 2013

ObamaCare 2014: Tale of Two Americas

Two Americas have emerged in health
care reform: states like California, which have embraced ObamaCare, have
enthusiastically implemented its key provisions, and are intent on boosting
enrollment and ensuring its success; and states like North Carolina, whose
political leaders oppose ObamaCare, resist its implementation, reject Medicaid
expansion, and hope that the program collapses.

Jonathon Oberlander and
Krista Perreira, “Implementing ObamaCare in a Red State – Dispatch from North
Carolina, New England Journal of Medicine, December 26, 2013

Given these dualities,
President Obama has two choices: one, compromise with his distractors or
confront them. I predict he will choose
that latter course by issuing executive orders and staking out his
philosophical differences with the GOP.
Bringing in John Podesta to spell out these differences is one signal of
this approach. Another is his history of taking unilateral actions, such as
ramming ObamaCare down the GOP’s throat,
changing the law 21 times without consulting Congress, using the IRS to punish his adversaries by
denying them tax-exempt status, repeatedly
deceiving the public with claims that could keep their doctor and health plan, and charging ahead with healthcare.gov to meet
a political deadline after being forewarned it was not ready and might fail.

This is a president that takes inordinate pride in his
namesake, ObamaCare. He is not about to change
it because of dropping polls showing distrust in his leadership or its lack of
workability. He will campaign on this
issue through a national PR effort, raising money from celebrities, exciting his
base with his partisan passion, issuing good news stories about Obamacare benefits.
He will try to work around Congress. He
will strike out with executive actions. He wlll demean and ridicule Republicans for failing
to cooperate.

But there are big Red Lines obstructing his path to November
2014 electoral glory. Two obstacles
are: one, the Red States with their 30
GOP governors, their 680 state
legislators, and the 63 Republican House members and Senators - all elected in the
2012 midterms; and two, the June 2012 Supreme Court decision allowing states to
opt out of Medicaid expansion. These
two events imperil the main intention of ObamaCare dream – to provide coverage
for the uninsured and underinsuref and to expand Medicaid..

But as the proverb says: the road to hell is paved with good
intentions. And as Joseph Epstein points
out in “ObamaCare and the Good Intentions Paving Co” WSJ, December 31, 2013), “
ObamaCare is a nearly perfect example of the Good Intentions Paving Co. at
work. A President and the leadership of
his party decide what it would be a fine thing to bring universal health
insurance to the nation – what a sweet notion, really – except when they enact
the law, it turns out to bring in its train confusion, anxiety, probably loss
of employment, added personal and public expense, and aggravation all around. “

Now the nagging thought of a repeat of the 2010 midterms in
the 2014 midterms haunts the Democratic party. For good reasons. The IRS scandal punishing conservatives, the horrendous healthcare.gov rollout, health plan cancellations exceeding
enrollments, and skyrocketing premiums and deductibles, have
aroused the Tea Party, mobilized conservatives,
and sunk Obama in the polls. Only
16 states have embraced Medicaid expansion, 25 have declined, and 34 have told the federal government: “You set up our exchanges. We do not believe
in them. You explain this confusing, complex, and controversial law. It’s your law, not ours.”

Or. in the words of Oberlander and Perreira in their NEJM
piece: “The ACA is a national law, but
its implementation varies substantially across the country. Two Americas
have emerged.”

The botched ObamaCare rollout, Obama’s known deceptions, and
widespread health plan cancellations, have intensified opposition to the health
law. This opposition will grow right up
to the November midterms, barring unforeseen
developments, such as a booming economy, sudden
public embrace of ObamaCare’s benefits,
and a perfectly functioning healthcare.gov website. These events could prevent another midterm
nightmare. Meanwhile Obama must figure out how to make the ACA work in states
whose governments are rooting for working to ensure its failure. And he must strive to keep the Good Intentions Paving C. from going out of business.

Tweet:America is divided into two
countries – one, favoring and embracing Obamacare, and two, the other rooting
for its failure.

Monday, December 30, 2013

I have composed 3200 blog posts over the
last 7 years under the blog title of “Medical Innovation and Health Reform.” As I write these pieces, I find myself
saying, “We can do better than this.”

I define
medical innovation as doing things simpler, cheaper, more conveniently, and
better. I define health reform as
changing things for the better.

In my opinion, current health reform efforts do not meet
these tests. The health law is too complicated,
expensive, inconvenient, and it has not improved quality.

We can make it simpler.

We can trust patients more by encouraging them to have health
savings accounts with high deductibles.
They can choose the care they want up to the level of the deductible,
and they can set aside money they do not use for health purposes for retirement
and other uses. We could issue a health
savings account to each citizen at birth and let them pass it on to their
heirs. Patients with “skin in the game” use less care and pay lower premiums.

We can make it less expensive by removing third parties from
the doctor-patient equation. Physicians
will tell you dealing with third parties accounts for more than half of their overhead. That is why doctors going into concierge
practices can cut their rates by more than half. We reduce premiums by cutting the number of
regulations with which doctors and hospitals must comply.

We can render it less expensive by making prices transparent, posting them in offices and hospitals and on
the Web. We can let patients shop across state lines for the best
price and the best listed outcomes. We can make all health transactions tax deductible. We can institute national tort reform, have health courts pay for medical injuries and make lawsuit-losers
pay, thereby reducing the number of frivolous
lawsuits and the high malpractice rates physicians and hospitals must pay.

We can transfer some decision making and patient support to
other health professionals rather than doctors and to patients themselves. Nurse practitioners and physician assistants are effective in treating patients. Patients already can interpret pregnancy
tests, glucose and hemoglobin A1C levels,
lipid results, the meaning of body mass indices, and DNA implications.

We can make care more convenient for patients and doctors. We can let patients choose their own doctor. We can let patients choose their own health
plan. We can encourage patients and
doctors to make better use of online information technologies.

The list of ways to do this is impressive and growing -
convenient scheduling, prescription renewals, posting of test results through physician
websites; email communication between patients and doctors, encouraging patients to compose their medical
histories through the use of clinical algorithms; having patients carry their medical histories
on cards in their wallets and purses; monitoring patients vital signs, heart rhythms, an complications remotely through embedded sensors; evaluating patients at home and in remote locations through Skype
and similar technologies; and predicting
future diseases and impact of treatment based on a person’s genomic makeup.

Tweet:We can
make better use of medical innovations, and we can achieve better health
reforms than we are now doing

Sunday, December 29, 2013

Obama’s 2nd Term Hinge of
Fate

To depend on or turn on, as in "Everything hinges on his decision."

Hinge, definition

To say that
President Obama’s 2nd term hinges on how ObamaCare turns may be an overstatement. But not by much. ObamaCare will dominate the political
discourse from now until the November midterms.
It is, at the same time, Obama's Achilles Heel and his Great Opportunity.

Already the
media are predicting chaos after January 1.
A perfect storm seems to be gathering over the healthcare.gov fiasco,
the millions of health plan cancellations,
and the uncertainty and skepticism among the public about what comes
next.

What can
President Obama do about this perfect storm ?
He can talk of the good things ObamaCare has wrought. He can launch a PR campaign to persuade the
public it is the right thing to do for the public good. He can mobilize his political and celebrity
surrogates to go forth and spread the word. He can seek to convince the invincibles. He can, in short, talk the good talk and promote the good cause. But these tactics may not be enough. Distrust of his role in the health law is simply too deep.

Obama can
do something else. He can be
humble. He can say the ACA hasn’t worked
out as planned. He can say mistakes were
made - unilaterally passing the law
without a single GOP vote and not living
up to his promises that people could keep their doctors and health plans. He can apologize for failing to bring down
premiums and deductibles. He can say
to contain these costs health
plans had to narrow the numbers of doctors and hospitals they could
access, that patients might have to switch
doctors, and they might see their benefits cut.

And he might
even follow the example of Winston Churchill in these dark days of World Ware II when Britain's fate hung in the balance. He can acknowledge the confusions, uncertainties, and unforeseen consequences the law has
generated. President Obama csn straightforwardly say things might go badly in the short term, in January when the law takes
effect and perhaps right up to the November midterms.

In 1942, when things were going badly for Britain in
World War II, with one British defeat after another in the deserts of North
Africa and the seas of Southeast Asia,
Churchill called for a Vote of Confidence in the House of Commons to
warn the Nation of dark days ahead and coming misfortunes.

Said
Churchill:

“There is no worse mistake in public
leadership than hold out false hopes soon to be swept away. The British people can face peril or
misfortune with fortitude and buoyancy, but they bitterly resent being
deceived or finding that those
responsible for their affairs are they themselves living in a fool’s paradise.
I felt it vital not only to my position but to the conduct of the war, to
discount future calamities by describing the immediate outlook in the darkest
terms.” (Winston Churchill, The Hinge of Fate, 1950).

Churchill
asked for a free debate, for things to be said in plain English. “No one need be mealy-mouthed, and no one
should be chicken-hearted in voting.”

Obama should
call for a free debate about the merits and faults of the health law. It has plenty of both. He should express both sides in his press
conferences and his State of the Union address in January, and he should pull
no punches in discussing either the bright and dark sides of the law. He
should acknowledge that he has made 21 changes in the law to correct its deficiencies,
many of which are self-inflicted and poorly thought out. He
should call for full debate and ask for a
Vote of Confidence in the primaries and the General Election in November. This is too large an issue to be swept
under the political rug or to generate false hopes.

Tweet:The ObamaCare issue will dominate the national political debate between
January and November, as it should.

·we are tolerant society capable of adjusting
to new and emerging social and cultural norms;

·we have a checks and balances political
system with a guiding constitution that
prevents one-sided governance or dominance by one political party;

·we have the ability to correct, modify,
and change our laws and even repeal them should they prove to unworkable for
the majority of our citizens;

·we have a high-tech, high touch medical system that most of our citizens approve
of despite its obvious faults – high prices and limited access to the vulnerable,
poor, and uninsured among us.

·we remain a world leader in producing technological
innovations that benefit and connect all peoples;

·we believe, in spite of our political beliefs, conservative,
liberal, independent, or libertarian, that a strong social net is
needed to protect the disenfranchised, and the rest us should pay to keep that
net intact.

Tweet: As
a U.S. citizen, I am thankful for our freedoms,
enterprising spirit, wealth, tolerance,
technological excellence, and abundance of choices.

Friday, December 27, 2013

Forecast
for 2014

Forewarned
forearmed.

Cervantes (1647-1616), DonQuixote de la Mancha

D.C.
= Darkness and Confusion

Washington
pundit on meaning of D.C. as in Washington, D.C.

George Carlin (1937-2008) once gave this nightly weather forecast: "Continued darkness with widely scattered light in the morning." I feel the same way about the Obamacare
forecast for 2014: Continued darkness until November 2014 followed by widely
scattered light for the remainder of President Obama’s lame duck term.

Here is the rest of the forecast.

1. Darkness and confusion will reign in
Washington and in contested Senate and House races until November

2.Republicans
will rain on Democratic parade by repeatedly
airing “ You can keep your doctor and health plan, Period” video clips and by featuring
unsubsidized voters who cannot afford new health exchange plans.

3.GOP
will retain House and win Senate by one vote. Six senators in states won by Romney
will lose.

4.Congress
will vote to repeal ObamaCare. Obama will veto, and veto will not be
overridden.

5.President
Obama’s approval rating will drop into low 30s,
and approval rating of health law will plunge to 25.

6. Ten million more Americans, not only in individual, but in big group markets,
will lose their coverage.

7.Ten
to twenty million Americans will join Medicaid ranks. Many of these will have hard time finding doctors to care for them because more than 40% of doctors will not accept new Medicaid patients because of low reimbursements and bureaucratic hassles.

8.A
number of lawsuits will successfully challenge President Obama’s ignoring and
unilaterally changing ObamaCare provisions without consulting Congress.

9. Costs of insurance and deductibles will
continue to rise as young fail to meet quota of 2.3 million by March 31, and death spiral, higher rates for older citizens, sets in.

10.More
Americans will lose their insurance than will be covered by health exchanges.

11.Penalties
for those who did not buy coverage or who were unable to do so because of healthcare.gov
malfunction will not be enforced or will be delayed because it will become a
raging controversy.

12.Democrats
will scramble for cover from ObamaCare and will ask for delay or suspension of individual
mandate and extension of employer mandate.

13.Stocks
for health plans will plunge as ObamaCare raises expenses and cuts
profits. Congress will be forced to bail
plans out to make ObamaCare viable.

14. There will continue to be clouds and turbulence until Congress presents and passes an alternative plan containing these features universal health tax credits, competition among health plans and providers across state lines, easily accessible health savings accounts, price transparency, disruptive innovations, fewer regulations, and national tort reform.

Tweet: The
weather forecast for 2014 for ObamaCare is continued Darkness and Confusion followed
by scattered light after November elections.

Thursday, December 26, 2013

ObamaCare
Legitimacy and Coercion Problems

The
care of human life and happiness, and not their destruction us the first and lonely
legitimate object of good government.

Thomas
Jefferson (1743-1826)

The Obama administration has a problem. Americans are unhappy with its
governance. Only 30% think the country
is headed in the right direction, and only 38% approve of the health care law. Their main gripes with the health law are
denial of personal choice, distrust of big government's competence, and difficulties and frustrations of signing up for health exchange plans.

Government distrust focuses on competence - the healthcare.gov fiasco – and coercion -
the use and abuse of “mandates” to force
people to buy something they do not want – unaffordable and expensive health
exchange plans containing benefits they do not want to subsidize
others.

The healthcare.gov rollout fiasco highlights the
competence problem. How could the
government be so incompetent as to
launch an untested website that is so hard to use? And how could government be so unfair that it would
impose penalties on people who were unable to sign on because of the botched
website? And what those millions of
cancelled policies? And what of those unaffordable premiums and soaring deductibles
for the unsubsidized and those promises you could keep your doctor and
your health plan?

And those “mandates”? That’s another kettle of foul smelling
fish. \How can you force people to buy
policies containing benefits they do not want, do not need, and will never use in order to subsidize other
people. The Obama administration has not
sold people that they must participate in the exchanges for collective action
for the common good.

As David Brooks wrote in his December 23 NYT column:
“It is pretty clear that the implementation of ObamaCare will set the tone of
how Americans think about government for years to come. There are two large questions to be settled,
which you might call competence and coercion?"

In America, with the penchant of its people for individual
choice, and given these overt displays of incompetence and mandates imposed
from above, how can you coerce people to
do what they don’t want to do, in the short-term as well as the long-term? The
Obama administration has responded by backing and filling holes in the law, by
loosening, delaying, and suspending objectionable provisions. And now it has granted “hardship exemptions”
to those who cannot even afford bronze health plans, the cheapest of them all. Thanks to the Internet, people are used to personal and decentralized choices.

When will the exemptions never end? When will
people consider the penalties for not signing up be considered
legitimate? Maybe never. As David Brooks so trenchantly says, “Government
lacks the legitimacy to coerce.”

Tweet:
Because
of incompetent rollout of healthcare.gov and unpopularity of coerced “mandates,”
implementation of ObamaCare will be difficult.

Monday, December 23, 2013

A President needs political understanding
to run the government, but he may be elected without it.

Harry
S. Truman (1884-1972), Memoirs, Volume II,
Of Trial and Hope

My E-book, Understanding ObamaCare: Travails of
Implementation, Notes of a Health Reform Watcher, will be out in January.

What is the
book about?

It is not so
much about understanding ObamaCare, but about Obama and his health law understanding America and
its general and healthcare culture.

To wit:

We are not
necessarily in this all together collectively.
We are in this separately as individuals as well.

As
individuals we rely upon one another, but we rely on ourselves as well. We expect to earn our own keep, to make our
own choices, to be self-reliant, to cherish common values that got us where we
are as a nation, to elevate ourselves to the level
of our talents, to realize our ambitions, to pay out of pocket for what we want,
and to help each other when in need.

We are in
this to enjoy our individual freedoms, to lead our lives as we see fit, to follow our own North Start, rather than to
be under national surveillance or marching orders.

We are a
diverse, pluralistic people, and we expect to be treated as such. Our medical system is diverse not uniform,
and its caregivers and receivers are heterogeneous not homogeneous. One size does not fit all. We cannot be standardized. Patients and doctors move to different
drummers, and each is perfectly capable of making medically intelligent decisions.

We are an
independent. not a dependent people.

We do not
like to watched or be lectured to about what we can and cannot do. We do not like too many rules and regulations.

We are entrepreneurial and enterprising. We like elbow and head room to rise above the common
herd. Given that room, we believe one
person raises the other up – to a higher level of personal, public, and
national achievement.

We are a
people of genius – a land where Steve Jobs, Bill Gates, Warren Buffett, and Oprah
Winfrey can rise to the top of wealth, power, and influence.

We are a
free-wheeling democracy, not a sclerotic welfare state. We believe people should be able to speak
their minds without being labeled as extremists or as politically incorrect.

We believe
people should be able to pick their own doctors and their own health plans, or
no health plan at all, and take their own medicine, even if that medicine is
ineffective and does not meet federal standards.

We believe
in specialized excellence and well as generalized compassion - in being the best and getting the best.

We are a
bottom-up. not a top-down society. Every region of the country and every state makes its own choices of what it wants and what is best for its fellow citizens, what institutions if supports, and what its people need..

We believe in
actions, not words, in results, no rhetoric, in excellence, not in control.

These days Americans are not fond of the word "mandate," perhaps because it rhymes with "dictate" and perhaps because we are increasingly distrustful of Big Government.

Tweet:Understanding Obamacare begins with understanding American culture
and what it stands for.

Says Robert Zirkelbach, spokesperson
for America’s health insurance plans, “ This type of last minute change will
cause tremendous instability in the marketplace and confusion and disruption
for consumers.”

Karen Ignani, AHIP president, is unhappy. She and her group, tried to kill the law when
it was being debated. And since its passage,
they have built up hopes the ACA’s new enrollees will reap billions of
dollars in new policies from the individual mandate.

Now she ruefully notes, individuals have “ a
path around the mandate.” This latest
tweak could cause AHIP to lose billions if it causes few people to sign up for
ObamaCare. The industry feels it may be victim of a flawed law that has gone off the rails in ways they
predicted it might.

The “catastrophic bare
bones”plan is merely the latest twitch

Of 20 of this year's tweaks in the multilayered ACA sandwich.

Having first opposed
and then supported the ACA, can AHIP now
take a principled stand,

When unexpected
changes like these may be more than their profit structure can withstand?

Friday, December 20, 2013

Another Day,
Another Individual Mandate Delay

Delay is preferable
to error.

Thomas Jefferson
(1743-1826), Letter to George Washington

Yesterday
the Obama administration issued another change, its 21st, in its health care
law.This change gives a “catastrophic
exemption “ to those whose plans have been cancelled for failure to meet
federal standards and who cannot afford a government plan. People will now be
able to keep their “bare bones” plans.This is in response to public outrage over plan cancellations for 6
million Americans and higher premiums and deductibles for replacement plans.

Some
are calling this latest federal action a “Hail Mary”pass to save ObamaCare and its unpopular individual mandate.

This “catastrophic exemption” raises a
fundamental question; Is ObamaCare an unworkable failure, a rolling
disaster,a cataclysmic
catastrophe,and merely the latest in a
string of strategic mistakes?

These
mistakes include:going whole hog on
reform rather than approaching it incrementally,arrogantly stiff-arming the GOP rather than
asking for their input into the specifics of the law,and changing the law 21 times through “executive
orders” through improvisational delays rather than consulting with Congress.

ObamaCare
may not yet be a catastrophe, but it’s getting there when its various
provisions,heretofore abstract theories
become concrete realities.The
American people do not like what they see, and they are responding by not
signing up for health exchanges and by expressing their disappointment in
countless polls.

The issues in
questionare mainly three: one distrust
because of broken government promises,
two, uncertainty about future costs and access to health plans and doctors; and
three, concern about government incompetence in rolling out
healthcare.gov.

Why
notback off, Mr. President, and admit
you made some mistakes in your path to reform?

Why not delay ObamaCare for a year?

Why not consider the obvious options – retaining coverage for
pre-existing illnesses and young adults under their parents’ plans, modifying
the individual mandate to fit the needs of the young and others, expanding Medicaid under the individual state’s
direction,selling plans across state
lines,tax credits for all, health
savings accounts for all,and national
tort reform?

Tweet:ObamaCare
is in trouble,as shown by government changing
it 21 times, e.g. “catastrophic exemptions” for those who can’t afford
it.

Thursday, December 19, 2013

Health Care
Inefficiency: Is There a Cure?

Curing Health
Care: Six Prescriptions for What Ails the Industry

HBS
Alumni Directory Bulletin,December 2013

Given
the complexity and resistance to change of the U.S. health system, is there a
cure for its complexity?And, if there
is, will the cure by politically, consumer, patient, physician, or managerially
driven?

I
do not know. But Regina Herzlinger,a
professor at Harvard Business School,has an idea who does.

In
her 1997 book, Who Killed HealthCare:
America’s $2 Trillion Medical Problem and the Consumer-Driven Cure, she
asserts only consumers can cure the system.We cannot, she says, depend on health-insurers, general hospitals,
employers, the U.S. Congress, or academics,to remake health care.

I
thought of professor Herzlinger when I read an eight-page section of the
December issue of the HBS Alumni Bulletin
entitled “Curing Health Care: Six Prescriptions of What Ails the Industry.”

Who
will prescribe the cure?Will it take
consumers or outside experts in managing complex social systems?

Maybe it will require imaginative people asking, not how to change what is, but what
could be.Maybe the present forces at
work are like the proverbial ostrich.They can run, but they can’t soar – innovate sufficiently with large enough ideas to reach a
practical solution.

In
any event, here’s a quick rundown on Harvard Business School alumni and faculty
members prescriptions for cure.

·The
first prescription, “Free the Data!” features the work of Jonathon Bush (MBA
1997).Bush is CEO of athenahealth, a
$42 million firm in Watertown, Massachusetts with a 30% annual growth
rate.His company sells cloud-based
software.The software helps physicians
communicate and share information.It
tracks and manages test results; aids patients in making appointments, and
seeing test results; and assists physicians in improving collections.His firm rises above the common IT herd,
by, among other things, allowing physician EHRs to talk to other EHRs and to do
so without installingin-office EHR
systems.

·The
second prescription, “Build a Killer App, “ describes the work of Halle Tecco
(MBA 2011) at Rock Health, a San Francisco-based company that organizes an
annualHealth InnovationSummit Conference and offers aspiring
entrepreneurs free-access in “The digital start-up space.”The root idea is to deliver health care at
the lowest possible cost in innovative ways.How this can be achieved, given
the burdensome handicaps imposed by government regulation, s challenges would-be
health entrepreneurs.Rock Health’s approach
is the classic SiliconValley solution - bring like-minded entrepreneurs together;let them socialize, compare notes, and
collaborate, and in the process, evolve innovative answers to tangled thorny
problems.

·The
third prescription,“Measuring Health
Care’s Real Costs, “ rests on the work of HBS professor Bob Kaplan.It concerns his work at MD Anderson in
Houston, where he has applied his concept of “Time-driving activity-based
costing (TBABC) to real time cancer care.TBABC identifies the time of people and equipment needed to perform a
service and to reduce time and cost, for example, to perform a test, schedule a
procedure, and see the results. Here the idea is that there always room for
improvement when an outsider with a critical eye looks a complex situations,
improvesand lowers cost, and measures results to provee the point..

·The
fourth prescription,“Making Medicine
Personal,” involves the work of Gregory Stock (MBA 1987).Stock speaks of preventing disease and
improving outcomes through the proactive use of simplegenetic markers, e.g., DNA in saliva and
buccal mucosa scrapping, to identify environment factors such as mercury in dental
fillings or in certain fish.By using
available techniques to identify toxins and their effects, Stock feels we may
be just at the beginning of a biomedical revolution through use of personal
genetic markets.“Things are about to
catch fire,” says Stock, “It’s a virtuous cycle where more access brings more
knowledge and value.”

·The
fifth prescription, “Leveraging Human Nature,” concerns the work of Nava
Ashral, HBS associate professor.In
Zambia, this behavioral economist has investigated how people’s behavior in
buying condomshas slowed the HIV
epidemic in that country.She found
hair dressers sold twice at many condoms are anybody else.She feels studying behavior patterns at the community level may be more productive in bringing aboutand improving outcomes than costs of care and
medically-induced changes.She and her
colleagues strive to get people to use what they need and to buy what they need
in the normal course of their day-to-day lives.

·The
sixth prescription, “Integrate Preventive Care and Payment,”relates the activities and highlights the idea
of Seth Blackley (MBA 2007),Frank
Williams (MBA 1977), Harvard alumnus Tom Peterson, all backed by the UPMC Health
Plan and by David Bradley (MBA 1977),Bradley
is founder andchairman of the Advisory
Board in Washington, D.C.Together they
participated in and helped found and further the mission of Evolent Health – to bring
together people, processes, and technologies to create a provider-lead,
clinician-drivensystem focusing on
preventive care. Evolent seeks to change the fundamental nature of health care payment- by intervening
in a more holistic way before patients reach the emergency room or the
physicians office or are hospitalized.The believe they can achieve this goal through
“full-care teams” and health care coaches instructing patients what to do short
of seeing health care professionals.Evolent is now working in 15 markets, soon to expand to 30 or 40
markets.TPG Growth, a venture capital
firm, recently invested $110 million in Evolent.Says Blackley, “Working in health care right
now is like joining Google in 1999,We’re
on the cusp of a reinvention of a huge sector of the economy.”

The Health Reform Maze

Buy the Book

Book Description: In this first book in a series of four, Richard L. Reece, MD. provides a unique view of the roll out, and run up, of the Affordable Care Act. Reece shows in this book the progress and facets of ObamaCare's marketers and messengers, as the day approached for the launch of health insurance exchanges - the single most public and problematic portion of the new law. This is a must read for anyone who wants to chronicle this attempt to organize more than one-sixth of the U.S. economy by adding layers of federal government control and regulations.

Reece has been writing about U.S. health care for more than 45 years. His knowledge and experience, added to his keen intellect and gift of subtle humor, make this book a valuable part of anyone's collection.